介入超声穿刺引流治疗胰周脓肿

目的 探讨采用介入超声技术行胰周脓肿引流的可行性.方法 回顾性分析2006年7月至2009年11月成都军区总医院收治的36例胰周脓肿患者的临床资料.结合胰周脓肿的部位、范围、形状等因素,确定穿刺点位置.根据穿刺点与靶区的空间对应关系,计算导管针进入的角度和方向,在超声引导下置入引流管引流.结果 36例患者均成功接受穿刺引流,33例治愈,治愈率为92%,平均治愈时间37 d.3例因穿刺引流效果欠佳改行开腹手术引流.3例患者并发肠外瘘,经非手术治疗痊愈.所有患者随访3～48个月,无脓肿残留或复发.2例并发1型糖尿病,1例消化不良,2例合并胆囊结石,经对症治疗痊愈.27例患者体质量较术前增加.结论 介入超声穿刺引流治疗胰周脓肿切实可行.     

介入超声穿刺引流治疗胰周脓肿

目的 探讨采用介入超声技术行胰周脓肿引流的可行性.方法 回顾性分析2006年7月至2009年11月成都军区总医院收治的36例胰周脓肿患者的临床资料.结合胰周脓肿的部位、范围、形状等因素,确定穿刺点位置.根据穿刺点与靶区的空间对应关系,计算导管针进入的角度和方向,在超声引导下置入引流管引流.结果 36例患者均成功接受穿刺引流,33例治愈,治愈率为92%,平均治愈时间37 d.3例因穿刺引流效果欠佳改行开腹手术引流.3例患者并发肠外瘘,经非手术治疗痊愈.所有患者随访3～48个月,无脓肿残留或复发.2例并发1型糖尿病,1例消化不良,2例合并胆囊结石,经对症治疗痊愈.27例患者体质量较术前增加.结论 介入超声穿刺引流治疗胰周脓肿切实可行.     

The role of percutaneous transhepatic abscess drainage for liver abscess

To evaluate the efficacy of percutaneous transhepatic abscess drainage (PTAD) as an initial choice of treatment for liver abscess, the medical records of 28 patients with liver abscess were retrospectively analyzed. The patients were predominantly men (23 of 28) with a mean age of 59 years (range, 19–86 years). Their chief complaints were fever (86%), right hypochondralgia (32%), and jaundice (11%). Fifteen of the 28 patients (54%) had hepatobiliary and pancreatic carcinoma, and 31% had postoperative liver abscess. PTAD was performed in 23 patients and surgical drainage in 5. The overall success rate for PTAD was 83%. The success rate for PTAD for patients with multiple abscesses was 83% (5 of 6), compared with a success rate of 82% (14 of 17) for patients with solitary abscess. The prognostic factors for survival were cancer and sepsis and the mortality rate for patients with cancer was 40% (6 of 15) while the mortality rate for patients with sepsis was 56% (5 of 9). As a complication of drainage, 1 patient (4%) in the PTAD group had pleural abscess due to the transpleural puncture. Our findings support the use of PTAD as the primary treatment for liver abscess, as it is safe and effective irrespective of the number of abscesses and the patient's condition. Received for publication on Sept. 7, 1998; accepted on Jan. 22, 1998     

CT-guided percutaneous drainage of psoas abscess

Two cases of pyogenic psoas abscess were diagnosed and treated by CT-guided percutaneous catheter drainage. In these 2 patients there was rapid clinical improvement and tomographic disappearance of the masses. Image-guided percutaneous drainage of psoas abscess appears to be a safe and effective alternate to open surgical drainage.     

Determinants for successful percutaneous image-guided drainage of intra-abdominal abscess

HYPOTHESIS: Characteristics of intra-abdominal abscess can be used to predict successful outcome for percutaneous catheter drainage (PCD). METHODS: We performed a multicenter prospective study of patients who had intra-abdominal infections treated with PCD and intravenous antibiotics. Multivariate regression analysis determined predictors of successful outcome. RESULTS: The study included 96 patients (59% men; mean +/- SD age, 48 +/- 17 years; mean +/- SD Acute Physiology and Chronic Health Evaluation II score, 7.4 +/- 4.9). Postoperative abscess was present in 53% of patients. Isolated microorganisms included Bacteroides species (17%), Escherichia coli (17%), Streptococcus species (14%), Enterococcus species (10%), and fungi (11%). Single abscesses were present in 83% of patients. Computed tomographic guidance was used for drainage in 80% of patients, and ultrasound was used in 20%. The duration of abscess drainage was less than 14 days in 64%. Complete resolution of the infection with a single treatment of PCD was achieved in 67 patients (70%), and with a second attempt in 12 (12%). Thirty-three patients (34%) had PCD for the resolution of intra-abdominal sepsis prior to an elective, definitive procedure. Open drainage as a result of PCD failure was required in 15 (16%) and was more likely in patients with yeast (P<.001) or a pancreatic process (P =.02). Postoperative abscess (P =.04) was an independent predictor of successful outcome. CONCLUSIONS: Percutaneous catheter drainage of intra-abdominal infections was effective with a single treatment in 70% of patients and increased to 82% with a second attempt. A successful outcome is most likely with abscesses that are postoperative, not pancreatic, and not infected with yeast. Percutaneous catheter drainage is now a commonly used staging method for the resolution of intra-abdominal sepsis prior to corrective operation.     

Immediate percutaneous drainage compared with surgical drainage of renal abscess

Purpose To compare immediate percutaneous drainage of renal abscess via ultrasonographic guidance to surgical drainage. Procedures This was a retrospective cross-sectional study of 27 patients (mean age of 59.37 ± 12.25 years) with renal abscesses. Immediate percutaneous catheter drainage was performed in patients with pus-containing cavities greater than 3 cm who consented in the emergency section (n = 12). Other patients underwent surgical drainage (n = 11). Both groups were also treated with empirical antibiotic therapy. Four patients were treated exclusively with antibiotics and were excluded from the analysis. Findings Abscess size on computer tomography (CT) was similar between the percutaneous catheter drainage (PCD) patients and open surgical drainage patients (7.47 ± 1.75 cm vs. 8.67 ± 1.87 cm; P = 0.13). There was no significant difference in mean duration of hospitalization (PCD, 19.5 ± 10.5 days; surgical drainage, 14.55 ± 4.52 days. P = 0.15). Larger abscess size and higher C-reactive protein levels were important prognostic factors in both groups. Microbiological analysis revealed Escherichia coli and Klebsiella pneumoniae in most abscesses. Conclusions Patients treated with percutaneous drainage for renal abscess had outcomes comparable to those treated with surgical drainage.     

Management of colorectal emergencies: percutaneous abscess drainage

Pelvic abscesses represent the most frequent complications of colorectal surgery. Percutaneous CT or US guided drainage can be an alternative to surgical drainage that is associated to a significant mortality rate. In the current study results of PAD, performed in 39 patients with pelvic or abdominopelvic abscesses were reviewed in order to evaluate reliability of such procedure. Major part of the collections 33/39 (85%) developed after resective colorectal surgery, and 20/39 (51%) were associated to anastomotic fistula; 22/39 (56%) were poorly defined; 16/39 (41%) were multiloculated; 16/39 (41%) had a stool contamination, 23/39 (58%) were greater than 10 cm; 14/39 (35%) were multiple. Thirty-five patients (89.7%) healed, despite high number of complex abscesses and complete resolution of sepsis was achieved in 5.1 +/- 2.9 days. CT proved to be the most reliable tool in assessing distinctive features of collections as well as in identifying the best route for drainage. Adequate size of the catheter was essential to get an effective drainage. In particular, large sized catheter (> 20 Fr) had to be used to drain collections associated to anastomotic fistulas with stool contamination. In four elderly neoplastic patients with chronic illnesses (10%), only a single small sized catheter could be positioned, because of patients poor compliance and PAD was inaffective. Nevertheless even those patients got a partial resolution of the sepsis and their general conditions markedly improved, so that they were able to underwent successful surgical drainage. In conclusion PAD is a safe and reliable tool that can be employed as an alternative to surgical drainage at least as first measure, even if complex pelvic abscesses are found.     

多房性细菌性肝脓肿手术和经皮穿刺引流的评价

目的 探讨治疗多房性细菌性肝脓肿的两种首选方案,比较手术和经皮穿刺引流的临床结果.方法 回顾性分析华西医院2003年6月至2008年6月收治的45例患者多房性细菌性肝脓肿的临床资料.根据手术方式分为2组,其中穿刺引流组21例,行B超或CT引导下经皮穿刺置管引流(pereutaneous drainage PD),开腹引流组24例,行经腹切开引流(surgical drainage SD).比较2组患者的退热时间、治疗失败、再次手术、住院天数及死亡率.结果 2组患者退热时间比较差异无统计学意义(4.85 d vs.4.38 d,P＞0.05),但是开腹引流组治疗失败率低(2例vs.9例,P＜0.05);再次手术机会小(1例vs.11例,P＜0.01);而且住院天数更短(8 d vs.11 d,P＜0.05).两组患者均无死亡.结论 根据结果显示,开腹引流在多房性细菌性肝脓肿治疗中能达到比经皮穿刺引流更好的临床结果.可提高成功率、减少再次手术机会和缩短住院天数,应作为首选治疗方案.     

介入超声微通道引流技术在胰周脓肿治疗中应用

目的 运用超声介入技术,建立胰周脓肿的微创化治疗.方法 对36例确诊胰周脓肿患者实施B超引导经皮穿刺置管引流,分析疗效.结果 36例均成功接受穿刺引流,33例治愈,治愈率91.7%,平均治愈时间67d,其中3例并发肠外瘘,非手术治愈.另3例因穿刺引流效果欠佳改行开腹手术引流治愈.结论 介入超声穿刺引流在达成胰周脓肿治疗目的 的同时,更以一种微创手段诠释了"损伤控制"的现代外科理念.     

超声引导穿刺置管引流与抽吸冲洗治疗肝脓肿的临床应用

目的探讨超声引导经皮穿刺置管引流冲洗与直接冲洗治疗肝脓肿的临床应用价值。方法对52例肝脓肿患者,63个病灶行超声引导经皮穿刺。小于5 cm的脓肿直接穿刺抽吸治疗,大于5 cm的肝脓肿置管引流。结果52例患者的63个病灶完全治愈,穿刺术后24 h无不良反应,4周治愈率达到78%、8周治愈率达到83%、6个月治愈率达100%。结论超声引导经皮穿刺置管引流与抽吸冲洗治疗肝脓肿,方法简单,安全有效、创伤小,可取代外科手术治疗肝脓肿。     

Management of splenic abscess in children by percutaneous drainage

Background/Purpose

Isolated splenic abscesses are rare in pediatric patients. The recommended treatment in the literature has been in favor of splenectomy, although conservative treatment with splenic preservation is being increasingly reported. We report successful management of 4 pediatric patients with splenic abscess by needle aspirations and antibiotics.

Materials and Methods

Four children (aged 7-11 years; male-female, 3:1) were admitted in our institution with history of high-grade fever with chills, anorexia, left hypochondrial pain, and splenomegaly. One child was a known case of thalassemia, and one had a history of typhoid fever. The others did not have any predisposing condition. Ultrasonography (USG) and computed tomographic scan of the abdomen showed a solitary abscess in the spleen in 2 patients and multiple abscesses in the other 2. Ultrasonography-guided needle aspiration in 3 cases revealed purulent fluid, which, on culture, grew Escherichia coli in 1 case, Salmonella paratyphi A in 1 case, but sterile in 1 case. Blood culture was sterile in all the cases, but Widal's test was positive in 2 patients. Treatment protocol included USG-guided needle aspiration of pus along with intravenous ceftriaxone, metronidazole, and amikacin for 3 to 12 weeks.

Results

All 4 patients showed a good response to conservative treatment. Serial USG showed gradual resolution of abscess, and none was subjected to splenectomy.

Conclusion

Isolated splenic abscess in children can be successfully treated with needle aspirations and intravenous antibiotics, thereby avoiding splenectomy.     

Computed-tomographically guided percutaneous transmastoid drainage of a cerebellar abscess

Computed-tomographic scanning demonstrated a cerebellar abscess in a patient with suppurative mastoiditis. Following radical mastoidectomy, computed-tomographically guided percutaneous drainage of the abscess resulted in substantial improvement in the patient's deteriorating neurologic condition. Because of the prior mastoidectomy, burr holes were not required for the drainage, permitting a percutaneous approach to a cerebellar lesion.     

Renal abscess owing to salmonella septicemia: percutaneous drainage

Renal salmonella abscess is an unusual entity. We report a case in which percutaneous pigtail catheter drainage was performed with computerized tomography guidance.     

Aortobifemoral perigraft abscess: treatment by percutaneous catheter drainage

There is significant morbidity and mortality associated with infected prosthetic aortic grafts. The preferred method of treatment is excision of the involved graft and revascularization. Percutaneous catheter drainage of abscesses under CT scanning or ultrasound guidance has been shown to be an effective alternative to surgery. This is a case of a patient with a retroperitoneal abscess involving the femoral limb of an aortobifemoral bypass graft, which was successfully treated by percutaneous catheter drainage. In selected high-risk patients this may be a safe alternative to surgical therapy.     

Current concepts of percutaneous abscess drainage in postoperative retention

In recent years, percutaneous abscess drainage (PAD) of intraabdominal abscesses has become an important tool with regard to the treatment of intraabdominal sepsis. The aim of this study is to assess the value of PAD in the treatment of postoperative retentions. Between 1995 and 1999, the postoperative course of 3 346 patients undergoing major abdominal surgery was analyzed. Mortality, morbidity, and comparison of different locations of intraabdominal abscesses were assessed. PAD was considered successful when the patient improved clinically within 24 hours, a decrease in the size of the abscess formation was noted, and complete recovery without further surgical intervention occurred. Out of 3 346 operated patients, 174 (5.2%) were diagnosed as having an intraabdominal abscess formation and were treated by PAD. In 63 patients the abscess developed within the upper quadrants, in 66 patients the abscess developed within the lower quadrants, and in the remaining 45 patients the abscess developed within the retroperitoneal cavity or pelvis. The success rate of PAD was 85.6% with a morbidity rate of 4.6%. The least successful location for PAD was the left upper quadrant. Patients with abscess drainage in the right upper and lower quadrant experienced a high success rate. One patient died due to the PAD procedure. Unsuccessful PAD was closely related to an increase in mortality. In the case of intraabdominal abscess formation after visceral surgery, PAD should be the primary procedure. Attention should be paid to abscess formations in the left upper quadrant because there is an increased likelihood of complications caused by PAD.     

The long-term results of percutaneous drainage of diverticular abscess

INTRODUCTION

Diverticulitis is a common condition occasionally complicated by abscess formation. Small abscesses may be managed by antibiotic therapy alone but larger collections require drainage, ideally by the percutaneous route. This minimally invasive approach is appealing but there is little information regarding the long-term follow-up of patients managed in this way. To address this question, we looked at a consecutive series of patients who underwent percutaneous drainage in our institution.

PATIENTS AND METHODS

A retrospective study was performed of patients undergoing percutaneous drainage of a diverticular abscess from 1999–2007.

RESULTS

A total of 26 abscesses were identified in 16 patients. In 69% of cases, the abscess was located in the pelvis. The mean size of the abscesses was 8.5 ± 0.9 cm. Drainage was performed under CT (83%) or ultrasound guidance. The mean duration of drainage was 8 days. Fistula formation following drainage occurred in 38% of cases. Eight patients (mean age, 71 years) underwent subsequent surgical resection 9 days to 22 months (mean, 7 months) following initial presentation. Eight patients with significant co-morbid conditions were managed by percutaneous drainage only. The 1-year mortality was 20% and resulted from unrelated causes. The long-term stoma rate was 13%.

CONCLUSIONS

Percutaneous drainage can safely be performed in patients with a diverticular abscess. It can be used as a bridge before definitive surgery but also as a treatment option in its own right in high-risk surgical patients. We believe percutaneous drainage reduces the need for major surgery and reduces the risk of a permanent stoma.     

Septic shock associated with pyogenic liver abscess rescued with percutaneous transhepatic abscess drainage

We report a case of septic shock associated with pyogenic liver abscess rescued with percutaneous transhepatic abscess drainage (PTAD). A 70-year-old male patient was admitted to our outpatient department of internal medicine with general fatigue, dullness of bilateral shoulders and extremities, appetite loss, weight loss, headache, and vertigo. Laboratory tests showed severe inflammatory indications, anemia, and high values of hepatobiliary enzymes and blood sugar. Abdominal ultrasonography and enhanced CT showed a pyogenic liver abscess of 10 cm in diameter at S 6-7 in the right hepatic lobe. The patient's condition deteriorated suddenly that night. From the results of abdominal ultrasonography and enhanced CT, we made diagnosis of septic shock associated with pyogenic liver abscess. Emergency abdominal ultrasound-guided PTAD was performed under local anesthetic. Postoperatively, the antibiotic was infused daily through a PTAD tube into the liver abscess space. He recovered and his laboratory tests improved gradually. On abdominal ultrasonography and enhanced CT, the liver abscess disappeared by 19th postoperative day, and PTAD tube was removed. There was no complication during PTAD treatment. We conclude that patients in septic shock should undergo further examinations immediately and treatment of the infected tissue should be started as soon as possible. PTAD may be an additional effective procedure for pyogenic liver abscess in septic shock. Furthermore, local antibiotic lavage through a PTAD tube into the liver abscess space may be an important supplementary method in the management of the illness.     

CT引导下置管引流局部强化化疗治疗结核性腰大肌脓肿和椎旁脓肿

目的：探讨CT引导下置管穿刺引流、局部强化化疗治疗结核性腰大肌脓肿和椎旁脓肿的安全性和有效性。方法纳入脊柱结核伴腰大肌脓肿和椎旁脓肿患者35例,进行CT引导下置管穿刺引流、局部强化化疗,同时行口服药物全身化疗18个月,每个月监测肝功、血沉,术后1、3、6、9、12、18、24个月复查,分析治疗前后临床表现、脓肿吸收、病椎愈合情况。结果平均随访时间25个月（18～36个月）,引流时间3周～3个月,35例均获得临床治愈,治疗前疼痛视觉模拟量表（visual analogue scale, VAS）评分平均3．6分（2～7分）,最后一次随访VAS评分平均1．1分（0～3分）,无神经功能障碍及其他并发症。结论 CT引导下置管引流、局部强化化疗治疗结核性腰大肌脓肿和椎旁脓肿安全有效,费用低、创伤小,适应证得当可代替病灶清除术。     

Primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage

We report a case of primary iliopsoas abscess successfully treated by ultrasonographically guided percutaneous drainage. A 56-year-old man presented at our hospital with lumbago, right-sided back pain, fever (temperature 38.5°C) and chills. On physical examination, we found dark red skin, swelling, and tenderness localized at the right side at the back of his waist. Laboratory examination showed leukocytosis (white blood cell count 9700/mm³) with a leftward shift and elevated C-reactive protein (5.2 mg/dl). Ultrasonography (US), computed tomography (CT), and magnetic resonance imaging revealed a hypodense lesion in the right iliopsoas muscle extending to the subcutaneous tissue. About 50 ml of thick yellow pus was obtained by ultrasonographically guided aspiration drainage. A drain catheter was inserted in the abscess cavity. Laboratory findings improved and clinical symptoms abated rapidly after drainage. On the twenty-first day after drainage, US and CT showed that the abscess was no longer present. The patient was discharged after 32 days of hospitalization. As possible primary diseases causing iliopsoas abscess, such as digestive tract disease, tuberculosis, and osteomyelitis, were not found, we diagnosed the disease as primary iliopsoas abscess. Although surgical drainage has been performed in most reported cases of iliopsoas abscess, this case report shows that ultrasonographically guided percutaneous drainage is also effective for treating primary iliopsoas abscess if it is diagnosed early enough. Received for publication on Aug. 20, 1997; accepted on March 4, 1998     

The subphrenic abscess. Surgical and/or percutaneous drainage

The results indicate that the low risk percutaneous drainage of subphrenic abscesses is only feasible in carefully selected patients. The surgical intervention remains the method of choice for the drainage of subphrenic abscesses in conditions such as multiple and complicated abscesses, unfavourable access to the abscess cavities or other pathological conditions. An early and decisive diagnosis is crucial for effective treatment of subphrenic abscesses either by percutaneous drainage or surgical intervention and antibiotic therapy.